6. Thinking blocks / decision-making problems with ADHD
Author: Ulrich Brennecke
Review: Dipl.-Psych. Waldemar Zdero
Thought blocks are a temporary restriction of cognitive performance that is often caused by acute stress. They occur with roughly the same frequency in ADHD with hyperactivity/impulsivity (ADHD-HI, ADHD-C) and ADHD with predominant inattention (ADHD-I).
Decision-making problems seem to occur more frequently in ADHD-I. High noradrenaline levels block the prefrontal cortex (PFC). This blockage leads to decision-making problems, as the PFC is important for weighing up options. Thinking blocks can also be symptoms of severe stress.
- 6.1. Thinking blocks as an ADHD symptom
- 6.2. Decision-making problems as an ADHD symptom
- 6.3. Neurophysiological correlates of mental blocks and decision-making problems
- 6.4. Thinking blocks as symptoms of stress
6.1. Thinking blocks as an ADHD symptom
Thought blocks are a temporary impairment of cognitive performance (formal thought disorder), which is usually caused by a high level of acute stress.
Exam blackouts are a typical example of mental blocks.
Thinking blocks occur with about the same frequency in ADHD-HI as in ADHD-I.
6.2. Decision-making problems as an ADHD symptom
Decision-making problems means problems with making decisions, not problems with the quality or correctness of decisions made.
Decision-making problems appear to occur significantly more frequently in ADHD-I than in ADHD. This suggests that the different manifestations have different neurophysiological correlates.
While ADHD-HI is increasingly correlated with overly spontaneous, overly impulsive decision-making, the ability to make a decision is often severely impaired in ADHD-I. Even simple decisions can trigger the feeling of being overwhelmed.
One study found that the decision quality problems of adolescents with ADHD resulted less from an affinity for risk than from suboptimal, because less complex evaluative decision making that did not take into account all factors relevant to the decision.1
6.3. Neurophysiological correlates of mental blocks and decision-making problems
High noradrenaline levels block the PFC via alpha-1 adrenoceptors and shift behavioral control to posterior brain regions.2345 As the PFC is very important for weighing up multiple decision options, blocking the PFC naturally leads to increased decision-making problems.
Decision-making problems must be distinguished from difficulties in the perception of time.6
For more details, see ⇒ Neurophysiological correlates of mental blocks and decision-making problems
6.4. Thinking blocks as symptoms of stress
Thinking blocks are also known as symptoms of severe stress.78 The most pronounced form is thought blocking.
Dekkers, Huizenga, Popma, Bexkens, Zadelaar, Jansen (2019): Decision-Making Deficits in Adolescent Boys with and without Attention-Deficit/Hyperactivity Disorder (ADHD): an Experimental Assessment of Associated Mechanisms. J Abnorm Child Psychol. 2019 Dec 28. doi: 10.1007/s10802-019-00613-7. ↥
Ramos, Arnsten (2007): Adrenergic pharmacology and cognition: focus on the prefrontal cortex. Pharmacol Ther. 2007 Mar; 113(3):523-36., Kapitel 6 ↥
Birnbaum, Gobeske, Auerbach, Taylor, Arnsten (1999): A role for norepinephrine in stress-induced cognitive deficits: α-1-adrenoceptor mediation in prefrontal cortex. Biol. Psychiatry 46, 1266–1274. ↥
Ramos, Colgan, Nou, Ovadia, Wilson, Arnsten (2005). The beta-1 adrenergic antagonist, betaxolol, improves working memory performance in rats and monkeys. Biol. Psychiatry 58, 894–900. ↥
ähnlich: Arnsten (2000): Stress impairs prefrontal cortical function in rats and monkeys: role of dopamine D1 and norepinephrine alpha-1 receptor mechanisms. Prog Brain Res. 2000;126:183-92. ↥
Shapiro, Huang-Pollock (2019): A diffusion-model analysis of timing deficits among children with ADHD. Neuropsychology. 2019 May 16. doi: 10.1037/neu0000562. ↥
Bartsch (2015): Störungen der Gedächtnisfunktion, Seite 44, zitiert nach Schmidtke (2013), Funktionelle Gedächtnis und Konzentrationsstörungen ↥